Browsing by Subject "Diagnosis, Dual (Psychiatry)"
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Item Open Access Influence of comorbid alcohol and psychiatric disorders on utilization of mental health services in the National Comorbidity Survey.(The American journal of psychiatry, 1999-08) Wu, LT; Kouzis, AC; Leaf, PJOBJECTIVE: This study sought to determine how comorbidity of psychiatric and substance abuse disorders affects the likelihood of using mental health services. METHOD: The analysis was based on data on adults aged 18-54 years in the National Comorbidity Survey (N = 5,393). Users and nonusers of mental health and substance abuse services were compared in terms of their demographic characteristics, recent stressful life events, social support, parental history of psychopathology, self-medication, and symptoms of alcohol abuse/dependence. RESULTS: The prevalence of service utilization varied by diagnostic configurations. Comorbid psychiatric or alcohol disorders were stronger predictors of service utilization than a pure psychiatric or alcohol disorder. Factors predicting utilization of services differed for each disorder. CONCLUSIONS: Since comorbidity increases the use of mental health and substance abuse services, research on the relationship of psychiatric and alcohol-related disorders to service utilization needs to consider the coexistence of mental disorders. Attempts to reduce barriers to help seeking for those in need of treatment should be increased.Item Open Access Substance use and mental diagnoses among adults with and without type 2 diabetes: Results from electronic health records data.(Drug and alcohol dependence, 2015-11) Wu, Li-Tzy; Ghitza, Udi E; Batch, Bryan C; Pencina, Michael J; Rojas, Leoncio Flavio; Goldstein, Benjamin A; Schibler, Tony; Dunham, Ashley A; Rusincovitch, Shelley; Brady, Kathleen TBACKGROUND:Comorbid diabetes and substance use diagnoses (SUD) represent a hazardous combination, both in terms of healthcare cost and morbidity. To date, there is limited information about the association of SUD and related mental disorders with type 2 diabetes mellitus (T2DM). METHODS:We examined the associations between T2DM and multiple psychiatric diagnosis categories, with a focus on SUD and related psychiatric comorbidities among adults with T2DM. We analyzed electronic health record (EHR) data on 170,853 unique adults aged ≥18 years from the EHR warehouse of a large academic healthcare system. Logistic regression analyses were conducted to estimate the strength of an association for comorbidities. RESULTS:Overall, 9% of adults (n=16,243) had T2DM. Blacks, Hispanics, Asians, and Native Americans had greater odds of having T2DM than whites. All 10 psychiatric diagnosis categories were more prevalent among adults with T2DM than among those without T2DM. Prevalent diagnoses among adults with T2MD were mood (21.22%), SUD (17.02%: tobacco 13.25%, alcohol 4.00%, drugs 4.22%), and anxiety diagnoses (13.98%). Among adults with T2DM, SUD was positively associated with mood, anxiety, personality, somatic, and schizophrenia diagnoses. CONCLUSIONS:We examined a large diverse sample of individuals and found clinical evidence of SUD and psychiatric comorbidities among adults with T2DM. These results highlight the need to identify feasible collaborative care models for adults with T2DM and SUD related psychiatric comorbidities, particularly in primary care settings, that will improve behavioral health and reduce health risk.Item Open Access Substance use disorders and psychiatric comorbidity in mid and later life: a review.(International journal of epidemiology, 2014-04) Wu, Li-Tzy; Blazer, Dan GGlobally, adults aged 65 years or older will increase from 516 million in 2009 to an estimated 1.53 billion in 2050. Due to substance use at earlier ages that may continue into later life, and ageing-related changes in medical conditions, older substance users are at risk for substance-related consequences.MEDLINE and PsychInfo databases were searched using keywords: alcohol use disorder, drug use disorder, drug misuse, substance use disorder, prescription drug abuse, and substance abuse. Using the related-articles link, additional articles were screened for inclusion. This review focused on original studies published between 2005 and 2013 to reflect recent trends in substance use disorders. Studies on psychiatric comorbidity were also reviewed to inform treatment needs for older adults with a substance use disorder.Among community non-institutionalized adults aged 50+ years, about 60% used alcohol, 3% used illicit drugs and 1-2% used nonmedical prescription drugs in the past year. Among adults aged 50+, about 5% of men and 1.4% of women had a past-year alcohol use disorder. Among alcohol users, about one in 14 users aged 50-64 had a past-year alcohol use disorder vs one in 30 elder users aged 65+. Among drug users aged 50+, approximately 10-12% had a drug use disorder. Similar to depressive and anxiety disorders, substance use disorders were among the common psychiatric disorders among older adults. Older drug users in methadone maintenance treatment exhibited multiple psychiatric or medical conditions. There have been increases in treatment admissions for illicit and prescription drug problems in the United States.Substance use in late life requires surveillance and research, including tracking substance use in the racial/ethnic populations and developing effective care models to address comorbid medical and mental health problems.Item Open Access Use of substance abuse treatment services by persons with mental health and substance use problems.(Psychiatric services (Washington, D.C.), 2003-03) Wu, Li-Tzy; Ringwalt, Christopher L; Williams, Charles EOBJECTIVES: This study provided population estimates of mental syndromes and substance use problems and examined whether the co-occurrence of mental health and substance use problems was associated with the use of substance abuse treatment services. METHODS: Study data were drawn from the 1997 National Household Survey on Drug Abuse. RESULTS: Of the total sample of 16,661 adults, 2 percent reported using services for alcohol or drug use problems in the previous year. Among the 3,474 (17 percent) who reported at least one alcohol or drug use problem, 6 percent used substance abuse services. Only 4 percent of persons who reported substance use problems alone received any substance abuse treatment service in the previous year. Only 3 percent of persons who reported alcohol use problems alone received such services. Among persons with one or more substance use problems, the prevalence of service use was 11 percent among persons who reported one co-occurring mental syndrome and 18 percent among those who reported two or more mental syndromes. Multiple logistic regression analyses identified a number of subgroups who might have needed substance abuse services but did not receive them, including women, Asians and Pacific Islanders, college graduates, persons employed full-time, persons who abused alcohol only, and persons with substance use problems who reported no coexisting mental syndromes. CONCLUSIONS: The rate of help seeking among persons with alcohol use problems is low, which is a public health concern.Item Open Access Using electronic health records data to assess comorbidities of substance use and psychiatric diagnoses and treatment settings among adults.(Journal of psychiatric research, 2013-04) Wu, Li-Tzy; Gersing, Kenneth R; Swartz, Marvin S; Burchett, Bruce; Li, Ting-Kai; Blazer, Dan GTo examine prevalences of substance use disorders (SUD) and comprehensive patterns of comorbidities among psychiatric patients ages 18-64 years (N = 40,099) in an electronic health records (EHR) database.DSM-IV diagnoses among psychiatric patients in a large university system were systematically captured: SUD, anxiety (AD), mood (MD), personality (PD), adjustment, childhood-onset, cognitive/dementia, dissociative, eating, factitious, impulse-control, psychotic (schizophrenic), sexual/gender identity, sleep, and somatoform diagnoses. Comorbidities and treatment types among patients with a SUD were examined.Among all patients, 24.9% (n = 9984) had a SUD, with blacks (35.2%) and Hispanics (32.9%) showing the highest prevalence. Among patients with a SUD, MD was prevalent across all age groups (50.2-56.6%). Patients aged 18-24 years had elevated odds of comorbid PD, adjustment, childhood-onset, impulse-control, psychotic, and eating diagnoses. Females had more PD, AD, MD, eating, and somatoform diagnoses, while males had more childhood-onset, impulse-control, and psychotic diagnoses. Blacks had greater odds than whites of psychotic and cognitive/dementia diagnoses, while whites exhibited elevated odds of PA, AD, MD, childhood-onset, eating, somatoform, and sleep diagnoses. Women, blacks, and Native American/multiple-race adults had elevated odds of using inpatient treatment; men, blacks, and Hispanics had increased odds of using psychiatric emergency care. Comorbid MD, PD, adjustment, somatoform, psychotic, or cognitive/dementia diagnoses increased inpatient treatment.Patients with a SUD, especially minority members, use more inpatient or psychiatric emergency care than those without. Findings provide evidence for research on understudied diagnoses and underserved populations in the real-world clinical settings.Item Open Access Vintage treatments for PTSD: a reconsideration of tricyclic drugs.(Journal of psychopharmacology (Oxford, England), 2015-03) Davidson, JonathanSerotonin (SSRI) and serotonin-norepinephrine (SNRI) reuptake inhibitors (SSRI) are the first-line recommended drug treatments for post-traumatic stress disorder (PTSD); but despite their benefits, much residual pathology remains and no new drugs have yet emerged with a clearly demonstrated benefit for treating the disorder. A case is made that tricyclic drugs deserve a closer look, based on their ability to affect several of the main neurotransmitters that are relevant to PTSD. Their promising efficacy, which was shown 30 years ago, had not been followed up, until a recent trial of desipramine found advantages over a SSRI in PTSD with comorbid alcohol dependence. Opportunities exist for studying newer and purportedly safer tricyclic formulations, as well as further the work with older, established compounds. A reappraisal of their risk:benefit ratio seems in order, when treating PTSD.